Chiari network for the interventional cardiologist: A hidden enemy at the heart gate – A systematic review of the literature

Ali, Hussam; Lupo, Pierpaolo; Cristiano, Ernesto; Nicolì, Leoluca; Foresti, Sara; Ambroggi, Guido De; Anderson, Robert H.; Lucia, Carmine De; Turturiello, Dario; Paganini, Edoardo Maria; Bessi, Riccardo; Farghaly, Ahmad Abdelrady Abdelsalam; Butera, Gianfranco; Cappato, Riccardo

doi:10.1016/j.ijcard.2022.12.046

Cited by 6 publications

(2 citation statements)

References 36 publications

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“…A CN is identified in 1.3-4% of autopsies. In most cases, as a single presentation, it is not associated with clinical symptoms [12]. However, 83% of this network is associated with PFO [11].…”

Section: Introductionmentioning

confidence: 99%

“…Hans Chiari, who first described CMI, was also the first to report a Chiari network (CN) in the heart's right atrium in 1897 [10,11]. The CN, typically located at the inferior vena cava-right atrium junction, presents as a reticulated structure extending from the Eustachian valve with multiple threads attached to different right atrium sites, such as the coronary sinus ostium, atrial septum, and terminal crest [11,12]. A CN is identified in 1.3-4% of autopsies.…”

Section: Introductionmentioning

confidence: 99%

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Unresponsiveness to Chiari Malformation Type I Surgery Can Be Related to the Accompanying Chiari Network

Keser,

Omar,

Kalyoncu Aslan

et al. 2024

Cureus

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Surgical treatment is indicated for Chiari malformation type 1 (CMI) with tonsillar descent (TD) of >5 mm and other clinical manifestations. However, some patients remain unresponsive to surgery; this is an active topic of discussion. A patient presented to the emergency department with dizziness and an impaired gait. He had a history of hypertension. Magnetic resonance investigations revealed a 9-mm TD and cervical syringomyelia. There was no evidence of interatrial septum pathology on transthoracic echocardiography performed preoperatively. Although his complaints were attributed to CMI and surgery was performed, his symptoms remained persistent. Two years later, when the patient's dizziness increased, a posterior fossa transient ischemic attack (TIA) was suspected. A large patent foramen ovale (PFO) and Chiari network (CN) were also detected on transesophageal echocardiography. His complaints were resolved following PFO closure. Our case suggests that neurosurgeons should be informed about the results of the companionship of a PFO and CN. Before deciding on CMI surgery for patients with only dizziness complaints, a detailed investigation of accompanying cardiac pathologies is paramount to ensure accurate diagnosis and treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unresponsiveness to Chiari Malformation Type I Surgery Can Be Related to the Accompanying Chiari Network

Keser,

Omar,

Kalyoncu Aslan

et al. 2024

Cureus

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Co-occurrence of patent foramen ovale and Chiari network in a diabetic patient

Abouzahir,

Belhouss,

Benyaich

2024

Med Leg J

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Introduction The coexistence of congenital cardiovascular anomalies provides valuable insights into the intricate nature of human cardiac anatomy and its potential interactions with underlying health conditions. This case report presents an autopsy analysis of a diabetic patient manifesting both a patent foramen ovale and a Chiari network. Case presentation A 26-year-old male with a history of type 2 diabetes mellitus was admitted with post cardiac arrest. He died despite resuscitative efforts. Autopsy revealed notable findings including a patent foramen ovale and a Chiari network. Post-mortem biochemical markers indicated elevated HbA1c level and hyperglycaemia. The absence of cryptogenic strokes or paradoxical embolism prompted exploration into potential relationships between these anomalies and metabolic disturbances, and prompts a discussion about whether the observed anatomical variations could potentially serve as risk factors contributing to the patient's death due to complications of diabetes. Conclusion The co-occurrence of a patent foramen ovale and a Chiari network within a diabetic patient, accompanied by elevated HbA1c level and hyperglycaemia, offers a unique perspective on the convergence of congenital cardiovascular variation and metabolic health. The juxtaposition of these anomalies with biochemical markers underscores the intricate interplay between cardiac morphology and metabolic conditions.

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Duo-decapolar catheter entrapment in the Chiari network: successful extraction with the snare catheter

Lee,

Rhee,

Lee

et al. 2023

Int J Arrhythm

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Background The Chiari network (CN) is the net-like embryonic remnants of the right valve of the sinus venosus. Catheter entrapment by CN is a not uncommon complication during catheter manipulation inside the right atrium (RA). Case presentation A 49-year-old man with atrial fibrillation was admitted for cryoablation. Transesophageal echocardiography revealed a prominent CN in the RA. Through the sheath placed in the right femoral vein, a diagnostic electrophysiologic duo-decapolar (DD) catheter (Livewire, St Jude Medical, St Paul, MN) was advanced. The catheter tip was knotted after multiple rotations in the RA to properly locate the DD catheter at the RA wall and coronary sinus (CS). Initial attempts to disentangle the folded catheter tip by traction and rotation maneuvers were unsuccessful. We inserted the large-bore sheath (Sentrant; Medtronic, 20 Fr) into the patient’s left femoral vein and then, captured the folded catheter tip with the 20-mm circular snare catheter (Snare Kit, Medtronic, Minneapolis, MN). Then, we cut the proximal portion of the DD catheter externally and removed it retrogradely through the Flexcath sheath. We found that the catheter tip was entrapped by the fibrous tissue of the CN. After a successful retrieval, cryoablation was conducted as planned. Follow-up echocardiography did not reveal any peri-procedural complications. Conclusions The electrophysiological procedure that exists at the RA entails a potential risk of catheter entrapment manipulating the catheter at the RA. If catheter entrapment occurs during the procedure, the entrapped catheter may be removed via a large-bore sheath using a snare catheter.

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Chiari network for the interventional cardiologist: A hidden enemy at the heart gate – A systematic review of the literature

Cited by 6 publications

References 36 publications

Unresponsiveness to Chiari Malformation Type I Surgery Can Be Related to the Accompanying Chiari Network

Unresponsiveness to Chiari Malformation Type I Surgery Can Be Related to the Accompanying Chiari Network

Co-occurrence of patent foramen ovale and Chiari network in a diabetic patient

Duo-decapolar catheter entrapment in the Chiari network: successful extraction with the snare catheter

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